Special Bid Request Form

Reseller's Details
TD Maverick Account Manager *
Reseller Name *
Reseller Account Number *
Reseller Contact Name *
Reseller Contact Email *
Reseller Contact Number *
Request Date *

DD
/
MM
/
YYYY

End User Details

End User Organisation Name *
Post Code *

Product Details

Quantity *
Which Product? *

Timings

Expected Purchase Date *

DD
/
MM
/
YYYY

Justification

Reseller Price
(to establish where we might need to be to win the opportunity) *
£
Pounds
.
Pence
Reason for discount *

Other Information